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<title>Untitled Document</title>

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<body>
    <div class="container_12">
    	<div class="grid_12">
        	<div class="top-menu">
            	Top-menu
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        <div class="grid_12 header">
        	<h1 class="logo"></h1>
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        <div class="grid_12">
        	<div class="main-menu">
            	Main Menu
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        </div>
        
        <div class="header1">
            <div class="grid_4 left">
                <div class="form-container">
                    <form action="" method="post">
                    <p class="legend"><strong>Note:</strong> Required fields are marked with an asterisk (<em>*</em>)</p>
                    <fieldset>
                        <div><label>Nama Lengkap</label><input type="text" name="nama_lengkap" /></div>
                        <div><label>Telp</label><input type="text" name="nama_lengkap" /></div>
                        <div><label>Alamat Email</label><input type="text" name="nama_lengkap" /></div>
                        <div><label>Jenis Kelamin</label>
                        <input type="radio" name="sex" />Laki-laki
                        <input type="radio" name="sex" />Wanita
                        </div>
                    </fieldset>
                    </form>
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                    Container
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            	Footer
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